Köhrmann M, Jüttler E, Huttner H B, Schellinger P D
Neurologische Universitätsklinik, Schwabachanlage 6, 91054 Erlangen.
Nervenarzt. 2007 Apr;78(4):393-405. doi: 10.1007/s00115-006-2246-0.
Even 10 years after the approval of thrombolysis this life-saving and disability reducing therapy is still underused. Important reasons for that are very strict inclusion criteria such as the early and narrow time-window, fear of bleeding complications and doubts regarding the effectiveness. An intensive and constant effort is required to educate the public that stroke is a treatable emergency. In addition to the medical reasons, economic considerations in a context of decreasing resources emphasize the importance of effective stroke treatment. The results of numerous recent studies such as the European register SITS-MOST help to strengthen the confidence in thrombolysis. In addition the development and advancement of new imaging tools such as multiparametric MRI and advanced CT-techniques will improve patient selection and may enable us to extend the time-window for treatment. Intraarterial thrombolysis, "bridging" methods and new devices for intravascular intervention are the subjects of intensive ongoing research. Even though no randomized trials are available intraarterial thrombolysis is the treatment of choice for acute basilar occlusion, but if this intervention is not available an intravenous approach may be an equal alternative.
即使在溶栓疗法获批10年后，这种挽救生命并减少残疾的疗法仍未得到充分利用。其重要原因包括非常严格的纳入标准，如早期且狭窄的时间窗、对出血并发症的担忧以及对有效性的怀疑。需要持续不断地大力开展工作，向公众宣传中风是一种可治疗的急症。除了医学原因外，在资源减少的背景下的经济考量凸显了有效中风治疗的重要性。近期众多研究的结果，如欧洲登记处的SITS - MOST，有助于增强对溶栓疗法的信心。此外，多参数MRI和先进CT技术等新成像工具的开发和进步将改善患者选择，并可能使我们能够延长治疗时间窗。动脉内溶栓、“桥接”方法和血管内介入的新设备是正在进行的深入研究的主题。尽管尚无随机试验，但动脉内溶栓是急性基底动脉闭塞的首选治疗方法，但如果无法进行这种干预，静脉途径可能是同等的替代方法。
